Instead, they take advantage of the innovation going on in industry and have it integrated into a common architecture fueled by the SOA and also extended by this open source platform. I don’t think it’ll be substitute products in open source, what we’re going to see is enabling a framework codifying the standards coming out of HHS and pieces that will enable the future state of the designed and integrated architecture so that industry knows how to behave within the joint iEHR.

Q: Which is an interesting comparison, because there’s evidence that it’s working for the NwHIN in terms of the federal government creating some standards but also pragmatically not dictating that those are the only standards.
A: One of the things we’ve done, Harris has taken what we did at the national level integrating the federal health agencies, the largest creators of that information, like DoD, VA and Indian Health, we were able to connect with the biggest consumers, CDC, the National Cancer Institute, Social Security. Then we took that same software baseline – this is a model for the open source – and we moved it to the states. So Florida, Oregon, Texas, some other work with Kaiser Permanente, they’re leveraging this open source created at the federal level and then applying that out into industry and creating alignment with what’s going on at the national level all the way down into these health information exchanges. That’s critical to fuel the transformation for the country. What we’re looking for out of IT is not just taking a broken analog paper-based system and digitizing that – we want to have a connected framework so we can literally improve quality and take out cost and if we don’t build that we will have failed with an IT approach. The framework being espoused in the joint iEHR is enabling that desired future state.

Q: Regarding SOA and the iEHR, how long will it take to plug applications into the SOA?
A: What we’re going to get to, and I think the whole point of the iEHR, is that we can’t take five years because the technology is moving too fast and the costs are escalating too quickly, the demand is too great. We have to get to a solution that begins to deliver real value in a couple years.

Q: What impact do you foresee the iEHR having, not just on the EHR market but on healthcare overall? The DoD and VA consider themselves, taken together with 18 million patients, a force that can move markets.
A: With the amount of training that occurs in the VA setting, 90 percent of physicians that go through, as part of their training they’re going to work at a VA facility at some point. The capacity to work with information in an integrated clinical enterprise will set the expectation for what you should be able to do as they move into private enterprise. A lot of what the DoD and VA do tends to proceed the type of integration and systems that you’ll find in the private sector and this interoperability we’re creating between the enterprises, when you look at meaningful use stage 2, that’s what has to happen, you have to have connected care not just digitized care in order to receive the incentives. It’s critical as a nation to improve care while taking out costs, we cannot afford to keep going the way we are. It’s this kind of innovation, program execution, and I want to say enterprise architecture – this is the genius of this approach – is not solving problems business by business, region by region, or application by application. Instead they have a holistic view of the architecture, a common way of executing in terms of procurement, a clarity of the desired end state. The DoD and VA are going to set a model that the rest of the country is going to want to follow.